Clinical Value Analysis Of Common Inflammatory Indexes Combined With APACHEⅡ Score In Sepsis With PICS

Objective : Combined with Acute Physiology and Chronic Health Evaluation(APACHEⅡ)to evaluate the clinical value of leukocyte count and serum procalcitonin(PCT)、Interleukin-6(IL-6)、C-reactive protein(CRP)in the early diagnosis and prognosis of sepsis complicated with Persistent Inflammation,Immunosuppression and Catabolism Syndrome(PICS).Methods: Retrospective analysis was conducted on the data of 66 sepsis patients with a hospital stay of > for 14 days admitted to the emergency department of the First Affiliated Hospital of Guangxi Medical University from September 2018 to December 2020.AAccording to the diagnostic criteria of persistent inflammatory immunosuppression catabolic syndrome(PICS),37 patients were divided into PICS group and 29 patients were divided into non-PICS group.General information,white blood cell count,IL-6,PTC,CRP and the worst indexes within 24 hours of admission were collected for APACHEⅡ score analysis according to the above results.Result: The APACHEⅡ score,90-day mortality rate,IL-6,PCT and CRP in the PICS group were compared with those in the non-PICS group,and the differences were statistically significant(P< 0.05).Univariate binary Logistic regression analysis showed that APACHEⅡ score,CRP,PCT and IL-6 were risk factors for PICS.The results of multivariate logistic binary regression model indicated that APACHEⅡ score,CRP,PCT and IL-6 were independent risk factors for PICS(P< 0.05).Receiver operating characteristic curve(ROC)analysis method was used to draw single-factor and multi-factor ROC curves,and the results showed that in the single-factor ROC curves: The area under the ROC curve(AUC)of Apache Ⅱ score was 0.854±0.047,the AUC of CRP was 0.815±0.051,the AUC of PCT was 0.799±0.054,and the AUC of IL-6 was0.827±0.049(P< 0.001).The best cutoff values for determining PICS incidence were APACHEⅡ score > 14,CRP > 117.87mg/L,PCT > 9.4ng/ml,and IL-6 >258pg/ml.APACHEⅡ score combined with CRP,PCT,IL-6 AUC value was0.982±0.013(P< 0.001)..The combined diagnosis of multiple factors was better than that of single factor.AUC value of APACHEⅡ score combined with CRP was 0.896±0.038,and AUC value of SOFA score combined with CRP was0.905±0.038(P< 0.001).Delong test showed that multi-factor combined diagnosis was better than single factor.According to the clinical outcomes of patients in the PICS group within 90 days divided into death group and survival group,further analysis showed that APACHEⅡ score was a relevant factor for PICS prognosis,with a regression coefficient of 0.342,P=0.021,OR value=1.407,while the correlation between early inflammatory indicators and the prognosis of patients with PICS was uncertain.Conclusion:For patients with sepsis with a hospital stay of > of 14 days,APACHEⅡ score,interleukin-6,procalcitonin,C-reactive protein and other indicators are effective indicators for early prediction of PICS with sepsis.The combined prediction of multiple factors was better than that of single factor,and the APACHE Ⅱ score combined with interleukin-6,procalcitonin and C-reactive protein could predict the incidence probability of PICS in sepsis patients.The APACHEⅡ score was associated with PICS outcomes,while the correlation between early infection indicators and PICS patient outcomes could not be determined.